The Back Story

If your back is screaming, you are not alone. According to neurosurgeon Kennedy Yalamanchili, 80 percent of us complain of back pain. Two-thirds will have recurring back pain. It’s the main reason we visit our family doctors and the No. 2 reason for missing work, behind common colds and respiratory issues.

That’s a whole lot of suffering, and the end often seems beyond sight. Many people believe the only relief is surgery, which prevents many from seeking help. The prospect of a botched procedure is so terrifying, many sufferers opt for it only when they are forced to remain immobile to avoid pain.

The pain can be temporary or chronic, caused by over-use or trauma. Surgery is sometimes necessary, but most often not. Yalamanchili will first recommend conservative treatment, starting with medication such as oral anti-inflammatories or muscle relaxants, or steroid injection. Failing that, he’ll move on to physical medicine, such as physical therapy or chiropractic. Only after those treatments have failed will he recommend surgery.

Surgery can correct issues such as spinal stenosis—a narrowing of the areas where nerves branch off the spinal chord—or bulging and herniated disks, the most common problem. Treatment ranges from procedures to clear nerve openings by removing the bone or ligament that pressures the offending nerve, to operations that repair the cartilage in problem disks, to spinal fusions.

For some issues, Dr. Frank J.E. Falco will recommend implantable stimulators that send a mild electrical signal up the spine. The sensation registers not as pain, but as a mild vibration. Because the stimulator can be removed easily, the patient doesn’t have to commit to a daunting and irreversible procedure.

“You get a chance to test it, take it around the block, see if it’s right for you. That takes some of the fear out of it,” Falco says. “There’s no way to try out a fusion. And once you’ve had a fusion, you’ve had a fusion.”

But Yalamanchili cautions that though stimulators can sometimes restore normal functioning, they only mask the pain, not remove the cause. For 10 percent of his patients, surgery is the best option.

Still, it’s a difficult decision. Yalamanchili estimates that 60 percent to 80 percent will respond well to surgery. The decision is, of course, the patient’s to make. Rest assured, “We don’t want to make anyone worse,” he says. “The key for us is to make sure patients know what they’re in for.”